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Abstract The ambition of universal health coverage entails estimation of the number, type and distribution of health workers required to meet the population need for health services. The demography of the population, including anticipated or estimated changes, is a factor in determining the ‘universal’ needs for health and well-being. Demography is concerned with the size, breakdown, age and gender structure and dynamics of a population. The same science, and its robust methodologies, is equally applicable to the demography of the health workforce itself. For example, a large percentage of the workforce close to retirement will impact availability, a geographically mobile workforce has implications for health coverage, and gender distribution in occupations may have implications for workforce acceptability and equity of opportunity. In a world with an overall shortage of health workers, and the expectation of increasing need as a result of both population growth in the global south and population ageing in the global north, studying and understanding demographic characteristics of the workforce can help with future planning. This paper discusses the dimensions of health worker demography and considers how demographic tools and techniques can be applied to the analysis of the health labour market. A conceptual framework is introduced as a step towards the application of demographic principles and techniques to health workforce analysis and planning exercises as countries work towards universal health coverage, the reduction of inequities and national development targets. Some illustrative data from Nepal and Finland are shown to illustrate the potential of this framework as a simple and effective contribution to health workforce planning.

This history of moral hazard in health insurance shows that this concept is different from how moral hazard is understood in economics outside of health. Health economists are divided on their understanding and conceptualization of moral hazard in health insurance and we show that these divisions can be organized along two main questions: one on the nature of demand for health care and one on the nature of demand for health insurance. The former revolves around the ability of consumers to make informed choices and, as a consequence, how we value the health care services that are consumed. The latter revolves around the idea that utility of consumption is significantly affected by changes in health status, and that health insurance might work, as a result, as an income transfer across states of the world rather than as protection against financial risk.

The present study aims to investigate empirically the socio-economic and demographic determinants of the demand for health care facilities in Pakistan. The study used cross sectional data available in Pakistan Social and Living Standard Measurement Survey (PSLM, 2015-16) and Household Integrated Income and Consumption Survey (HIICS, 2015-16). An ordinary least squares method was used to estimate multiple regression model. The study found that household income, education of the household head, age of the of the household head, and household size were the significant determinants of the demand for health care services in Pakistan. In addition, the study also found that rural households spent more on health care than urban households. Diagnostic tests including tolerance and VIF showed that the estimated model had no issue of multicollinearity. Kolmogorov-Smirnov and Shapiro-Wilk tests implied the data followed normality. Similarly, Breusch-Pagan and Koenker tests confirmed that heteroscedasticitywas not a problem. The study concluded that household income, education and household size are the most important variables affecting the health care demand. The study recommended that efforts are needed to enhance household income and education that may lead to better health facilities. [ABSTRACT FROM AUTHOR]

The ambition of universal health coverage entails estimation of the number, type and distribution of health workers required to meet the population need for health services. The demography of the population, including anticipated or estimated changes, is a factor in determining the 'universal' needs for health and well-being. Demography is concerned with the size, breakdown, age and gender structure and dynamics of a population. The same science, and its robust methodologies, is equally applicable to the demography of the health workforce itself. For example, a large percentage of the workforce close to retirement will impact availability, a geographically mobile workforce has implications for health coverage, and gender distribution in occupations may have implications for workforce acceptability and equity of opportunity. In a world with an overall shortage of health workers, and the expectation of increasing need as a result of both population growth in the global south and population ageing in the global north, studying and understanding demographic characteristics of the workforce can help with future planning. This paper discusses the dimensions of health worker demography and considers how demographic tools and techniques can be applied to the analysis of the health labour market. A conceptual framework is introduced as a step towards the application of demographic principles and techniques to health workforce analysis and planning exercises as countries work towards universal health coverage, the reduction of inequities and national development targets. Some illustrative data from Nepal and Finland are shown to illustrate the potential of this framework as a simple and effective contribution to health workforce planning. [ABSTRACT FROM AUTHOR]

Nonlinear price schedules generally have heterogeneous effects on health-care demand. We develop and apply a finite mixture bivariate probit model to analyze whether there are heterogeneous reactions to the introduction of a nonlinear price schedule in the German statutory health insurance system. In administrative insurance claims data from the largest German health insurance plan, we find that some individuals strongly react to the new price schedule while a second group of individuals does not react. Post-estimation analyses reveal that the group of the individuals who do not react to the reform includes the relatively sick. These results are in line with forward-looking behavior: Individuals who are already sick expect that they will hit the kink in the price schedule and thus are less sensitive to the co-payment. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Although medical savings accounts (MSAs) have drawn intensive attention across the world for their potential in cost control, there is limited evidence of their impact on the demand for health care. This paper is intended to fill that gap. First, we built up a dynamic model of a consumer's problem of utility maximization in the presence of a nonlinear price schedule embedded in an MSA. Second, the model was implemented using data from a 2-year MSA pilot program in China. The estimated price elasticity under MSAs was between -0.42 and -0.58, i.e., higher than that reported in the literature. The relatively high price elasticity suggests that MSAs as an insurance feature may help control costs. However, the long-term effect of MSAs on health costs is subject to further analysis. [ABSTRACT FROM AUTHOR]

Establishing how to reform the cost-sharing policy to reduce waste in health-care utilisation is an important issue, especially in an ageing society. Using a generalised method of moments (GMM) for the dynamic panel count model during the period 1997-2007 from the National Health Insurance (NHI) programme in Taiwan, this study examines the effects of persistent behaviour and the cost-sharing policy on outpatient medical utilisation for Taiwan's elderly. Empirically, we find positive and negative coefficient estimations for persistent behaviour and price elasticity, respectively, thereby creating a clear trade-off effect of the cost-sharing policy on health-care utilisation. Furthermore, our study finds that the short-run price elasticity (−0.2561) is always smaller than long-run elasticity (−0.4052). Finally, the empirical results indicate that the price elasticity for females and patients with high medical expenditure, low income, high chronic diseases and good health is higher than that for males and patients with low medical expenditure, high income, low chronic diseases and bad health. [ABSTRACT FROM AUTHOR]

In response to the DRC's 10th Ebola Virus Disease (EVD) outbreak, the government subsidized routine health services in select health zones with the goal of maintaining routine service volumes. We assess the impact of the initial and revised Free Care Policies (FCP) on total clinic visits, uncomplicated malaria, simple pneumonia, fourth antenatal care clinic visits, and measles vaccinations, testing the hypothesis that routine services would not significantly decrease during the FCP. We used data from the DRC's national health information system spanning January 2017 to November 2020. Intervention facilities were those that were initially and secondarily enrolled in the FCP, which occurred in August 2018 and November 2018, respectively. Comparison facilities were limited to the North Kivu Province and were from health zones that recorded at least one case of Ebola. A controlled interrupted time series analysis was conducted. The FCP appeared to have a positive effect in increasing overall clinic attendance rates, uncomplicated malaria case rates, and simple pneumonia case rates in those health zones where the policy was enacted relative to comparison sites. The longer-term effects of the FCP were mostly non-significant or, if significant, relatively modest in nature. Rates for measles vaccinations and fourth ANC clinic visits appeared to be unaffected or minimally affected, respectively, by the implementation of the FCP and relative to comparison sites. We did not observe the decrease in measles vaccinations that has been observed elsewhere. The study is limited in that we were unable to account for health facility bypassing and service volumes at private health facilities. Our findings provide evidence that FCPs can be used to maintain routine service provision during outbreaks. Additionally, the study design demonstrates that routinely reported health information from the DRC are sensitive enough to detect changes in health policy. • The Democratic Republic of Congo enacted a free health care policy during the 2018 Ebola outbreak. • The policy was associated with increased visits overall, and visits for malaria and pneumonia. • Decreases in measles vaccination were not observed while the free care policy was in effect. [ABSTRACT FROM AUTHOR]

Women are deprived and neglected in all respects, especially in the rural areas of the country. This attitude has a negative impact on their health status. The study attempts to examine the health status of the rural married women, especially for Muslim married women belonging different groups, viz., reproductive group, premenopause group and menopause group. This commentary focuses on health status of rural Muslim married women in Cachar district based on their health indicators. This study also attempts to find the health infrastructure that prevails in this area and the demand for the health care for them. The study reveals that most of the women, especially under the reproductive group, suffer from acute malnutrition problem, while women belonging to premenopause and menopause group face the problem of overweight and obesity, mostly. Due to shortage of health care facilities, there is a high demand for health care. The study reveals that household size, per capita income, distance of the health centre from house, per capita area of house and kachcha house are the significant determinants of demand for health care facilities. [ABSTRACT FROM AUTHOR]

Little is known about how patients dynamically respond to a forthcoming reduction in health care out-of-pocket prices. Using a kinked Donut Regression Discontinuity design with kinks entering and exiting the donut, we evaluate a Swedish cost-sharing policy, where primary care out-of-pocket prices were eliminated at age 85. We find evidence of forward-looking moral hazard with older adults delaying primary care visits up to four months before the out-of-pocket elimination and shifting these visits until shortly after. These health care delays are driven by non-urgent care: non-physician visits, planned visits and follow up visits. We find no evidence of severe negative health effects in the short-term as a result of the delay. Contrary to our finding of forward-looking behavior with respect to out-of-pocket prices, we do not find evidence of typical moral hazard, as we do not find a persistent increase in primary health care use after the copayment elimination., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022. Published by Elsevier B.V.)

The aim of this article is to identify the main tipping points likely to have an impact on health care demand in developed countries. The article is based on several exchanges between health care experts within the framework of a working group coordinated by the authors. This article argues that there is a possibility of change in the determinants of health care demand in developed countries. Over the medium and long-term, health care demand might no longer be expressed mostly by patients asserting their right to treatment. Instead it will be motivated more by the duty of each citizen to do everything possible to stay healthy. This transition from a "right" to a "duty" is a logical extension of various movements already observed in the health care sector. [ABSTRACT FROM AUTHOR]

ABSTRACT Hurdle models are frequently used to model count data. Recent developments in the count data literature make it possible to relax commonly imposed assumptions of these models. On the basis of these findings, two extensions of hurdle models that make popular specifications more flexible are developed. Both extensions nest the models that have been used so far, so they can be tested by appropriate parametric restrictions. An example from health economics illustrates the relevance of both model extensions. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper develops a Bayesian spike and slab model for zero-inflated count models which are commonly used in health economics. We account for model uncertainty and allow for model averaging in situations with many potential regressors. The proposed techniques are applied to a German data set analyzing the demand for health care. An accompanying package for the free statistical software environment R is provided. [ABSTRACT FROM AUTHOR]

Abstract: The emergence of the Internet made health information, which previously was almost exclusively available to health professionals, accessible to the general public. Access to health information on the Internet is likely to affect individuals'' health care related decisions. The aim of this analysis is to determine how health information that people obtain from the Internet affects their demand for health care. I use a novel data set, the U.S. Health Information National Trends Survey (2003–07), to answer this question. The causal variable of interest is a binary variable that indicates whether or not an individual has recently searched for health information on the Internet. Health care utilization is measured by an individual''s number of visits to a health professional in the past 12 months. An individual''s decision to use the Internet to search for health information is likely to be correlated to other variables that can also affect his/her demand for health care. To separate the effect of Internet health information from other confounding variables, I control for a number of individual characteristics and use the instrumental variable estimation method. As an instrument for Internet health information, I use U.S. state telecommunication regulations that are shown to affect the supply of Internet services. I find that searching for health information on the Internet has a positive, relatively large, and statistically significant effect on an individual''s demand for health care. This effect is larger for the individuals who search for health information online more frequently and people who have health care coverage. Among cancer patients, the effect of Internet health information seeking on health professional visits varies by how long ago they were diagnosed with cancer. Thus, the Internet is found to be a complement to formal health care rather than a substitute for health professional services. [Copyright &y& Elsevier]

This study estimates the effect of employment-based private health insurance (EPHI) on the use of covered health care services based on Danish survey data collected in 2009. The paper provides some of the first estimates of how EPHI affects the use of health care services in a Scandinavian context. The effect of EPHI is estimated using propensity score matching. This method is shown to provide plausible estimates given the institutional setting of EPHI in Denmark and a wide set of relevant covariates. Considering the full sample of occupationally active, it is found that EPHI does not significantly affect the probability of having had any hospitalisations, physiotherapist, chiropractor, psychologist, specialist, or ambulatory contacts within a 12 month period. Restricting the analysis to the subsample of privately employed, the estimated effects for ambulatory contacts and hospitalisation are somewhat higher and statistically significant. More precisely, it is found that EPHI increases the probability of hospitalisation from 5.1 to 8.5% and the probability of having had any ambulatory contacts from 17.9 to 23.3% among the privately employed. [ABSTRACT FROM AUTHOR]

The article is an attempt at diagnosing training needs of the employees of units operating in health care sector in the Podkarpacie Province. In times of permanent changes affecting each sphere of economy, providers of health care services cannot afford to remain outside this trend. Improving qualifications, adaptability of the offer, influencing its quality, and above all, the awareness of the necessity of these changes, have become an element which is fully integrated also with this sphere of public sector operations. Taking into account the above, the article verifies not only training needs articulated by employees of Health Care Centers (HCC) operating in the Podkarpacie Province, but also the way they are perceived by the managers of these centers, the ability to define training needs and their compatibility with characteristic features of analyzed HCCs. Therefore special emphasis has been placed on demonstrating the variety of diagnosed training needs with reference to such criteria as the size of analyzed centers, the market serviced by them, and their location. These determinants allowed us to conduct a complex analysis of conditions and structure of voiced need for subject training, and as a consequence, contributed to diagnosing the expectations of the health care sector concerning initiatives improving the quality of public services in the health care services area. [ABSTRACT FROM AUTHOR]

Abstract: Financial incentives are increasingly being advocated as an effective means to influence health-related behaviours. There is, however, limited evidence on whether they work in low-income countries, particularly when implemented at scale. This paper explores the impact of a national programme in Nepal that provides cash incentives to women conditional on them giving birth in a health facility. Using propensity score matching methods, we find that the programme had a positive, albeit modest, effect on the utilisation of maternity services. Women who had heard of the SDIP before childbirth were 4.2 percentage points (17 percent) more likely to deliver with a skilled attendant. The treatment effect is positively associated with the size of the financial package offered by the programme and the quality of care in facilities. Despite the positive effect on those exposed to the SDIP, low coverage of the programme suggests that few women actually benefited in the first few years. [Copyright &y& Elsevier]

In this paper, we examine the relationships between health care visits to general practitioners, public and private sector specialists using data from Italy, which has a mixed public–private health care system. We develop a simultaneous equations model that allows for the discreteness of measures of utilization and estimate this model using maximum simulated likelihood. Once common unobserved heterogeneity is properly accounted for, general practitioners, public and private specialists are found to be substitute sources of medical care. In contrast, a naive model finds they are complements. [Copyright &y& Elsevier]

Choosing optimal health insurance coverage involves a trade-off between the gain from risk reduction and the deadweight loss from moral hazard. This paper examines this trade-off empirically by estimating both the demand for health insurance and the demand for health services. It relics on data from a randomized controlled trial of cost-sharing's effects on the use of health services and on the health status for a general, non-elderly population. [ABSTRACT FROM AUTHOR]

We apply several estimators to Indonesian household data to estimate the relationship between health insurance and the number of outpatient visits to public and private providers. Once endogeneity of insurance is taken into account, there is a 63 percent increase in the average number of public visits by the beneficiaries of mandatory insurance for civil servants. Individuals' decisions to make first contact with private providers is affected by private insurance membership. However, insurance status does not make any difference for the number of future outpatient visits.